Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit

Abstract

A combination of factors must be taken into account to estimate a critically ill cancer patient's prognosis in the ICU. The APACHE III scoring system alone should not be used to make decisions about therapy prolongation. Admission to the ICU worsens the prognosis of a cancer patient substantially; however, as ICU mortality is 47%, comparable with severely ill noncancer patients, general reluctance to admit cancer patients to an ICU does not seem to be justified.

General Prognostic Scores in Outcome Prediction for Cancer Patients Admitted to the Intensive Care Unit

“…Many epidemiological studies of cancer patients admitted to the ICU have been conducted either in university cancer referral centers or in exclusively oncological ICUs. 10,[15][16][17] Therefore, extrapolation of findings to general ICUs and hospitals is not straightforward, and each ICU should ideally develop its own triage criteria and periodically evaluate and review its performance. 14 Nowadays, shortages of available ICU beds are common, and intensivists prioritize admissions of critically ill patients.…”

“…The results of evaluations of these general prognostic models in cohorts of cancer patients have been either positive 17,[21][22][23][24][25][26][27] or negative. 16,[27][28][29] Taking these factors into account, we conducted this study to determine the characteristics and outcomes of cancer patients admitted to the ICU, identify risk factors associated with mortality, evaluate and compare the effectiveness of established general scoring systems (APACHE II, SAPS II, and SOFA) in the prediction of ICU mortality of cancer patients, and determine if the addition of other predictors of mortality to these established scoring systems could improve their performance.…”

Outcome in critically ill cancer patients: past and present

“…The high mortality of more than 80% in patients requiring mechanical ventilation (Table 1) [8][9][10][11][12][13][14][15] , increasing to more than 90% to 95% in patients developing multiple organ failure or who require renal replacement therapy during ICU stay 12,[16][17][18] , particularly in the transplant setting [19][20][21] , together with the severe emotional burden endured by these patients and their relatives, and the considerable costs of advanced and prolonged life-supporting therapy 13 resulted in a general reluctance to admit such patients to the ICU 2,6,7 . However, over the past few years, several centres throughout the world have been reporting on increasingly improving survival in critically ill patients with hematological malignancies and solid tumors [22][23][24][25][26][27][28][29][30][31] , approaching survival rates reported in general ICU patients 32 . In a case-historical control study 22 , Azoulay et al reported a four-fold lower risk of death in cancer patients who required mechanical ventilation between 1996 and 1998 as compared with 1990-1995.…”

Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States

“…[7][8][9][10] In oncologic patients, acute respiratory failure (ARF) is the most common cause of ICU admission and the leading non-relapse cause of mortality following chemotherapy or BMT. [11][12][13] Need for mechanical ventilation is a major determinant of prognosis in oncology patients with an ICU mortality exceeding 75% for patients who have respiratory failure associated with ARDS. [14][15][16][17] Approximately 25% of all BM recipients ultimately require mechanical ventilation for respiratory failure, usually within 60 days of marrow infusion.…”